Male involvement in the informal urban settlements of Nairobi

The majority of residents of informal settlements in Nairobi are low income earners who often cannot afford the cost of accessing health care services. Families are forced to prioritize their basic needs such as food, water, shelter and clothing, leaving little or no funds for medical care. In a context where less than 25% of people have prepaid medical insurance, the out-of-pocket expenses when illnesses strike often leave families in a precarious situation. While the National Health Insurance Fund (NHIF) has been revised to include people working in informal sectors, many low income earners cannot afford to pay the entire monthly premium upfront. Health service delivery in informal settlements is dominated by small private for-profit clinics that do not offer the free maternity services introduced by the government in 2013 andwhich are currently limited to the public sector.  

Malteser International is implementing a flexible payment system to enable patients in informal settlements to make pre-payments for maternity services, using their mobile phones. The innovation is based on lessons learned from other sectors, where flexible pre-payment has been shown to increase access to financial products such as personal and business loans, and mobile phones have been used to promote savings for anticipated expenses. The M-Afya mobile application allows the mother and her family and friends to set aside small amounts of money during pregnancy to cover the costs of delivery, using MPESA. The money is saved in a protected account that can only be used for health services at designated facilities, promoting access to quality care. In addition to the financial savings function, the M-Afya system is also used to send simple mobile phone messages to the mother and her partner about maternal and newborn health, thereby acting as a platform for client education. It also sends reminder messages for clinic
appointment dates and payments.

Right from the design stage of the M-Afya intervention, Malteser observed that men in the informal settlement of Embakasi had a limited role in reproductive, maternal, newborn and child health (RMNCH). Generally, pregnancy and birth were deemed as a woman`s domain and men were only expected to offer financial support to their spouses. Being an urban population, sociocultural beliefs, attitudes and practices on reproductive health varied widely but prejudiced against men who participated in “women’s issues” were common.  For instance, men who spent too much time in the company of their
wife were perceived as weak. To address the situation, the M-Afya project integrates male involvement in various interventions where men become supportive partners and agents of positive change.

The project sensitizes men on the importance of assisting their partners to access maternal, newborn and child health (MNCH) services by providing financial, emotional and motivational support. 
Through men to men dialogue forums, male MNH ambassadors and M-Afya short messaging platform, the project seeks to eliminate negative gender-based stereotyping, myths and misconceptions that hinder male participation in maternal and child health services.  Realizing the low knowledge levels on RMNCH among men, the project sends simple mobile phone messages on the developmental progress of their
unborn babies, nutrition requirements of pregnant women, the importance of seeking skilled health care, danger signs in pregnancy and newborns etc. In addition, the project holds quarterly men to men forums during which men share and learn from each other.

The sessions are facilitated by the project and county teams and serve as a safe space for men to discuss pertinent issues that inuence their decision making on issues related to MNCH. This forum also provides a basis for more detailed, personal, and in depth discussions on the messages shared via the short messaging service platform.

To date the project has reached over 500 men through men to men forums, M-Afya ambassadors and mobile phone messages. These efforts to increase male involvement have contributed to an increased number of women seeking antenatal care, skilled birth attendance, postnatal care and child immunisation in 10 private health facilities supported by the M-Afya project. “Nowadays out of 10 women coming to the clinic, at least 3 will be accompanied by their partners unlike before when we hardly saw any man in antenatal or postnatal care sessions. I am even seeing men coming to discuss family planning.” Says Mildred, a Nursing Ocer at Unity Nursing Home.

Bahati is a resident of Kayole Estate and participated in the M-Afya male involvement activities. Bahati regularly accompanies his wife to Patanisho Nursing Home, one of the project supported clinics. He narrates the impact this involvement had on him: “I thought my wife was just fussy when she kept asking me to accompany her to the clinic, I wondered why I should go as she is the one who is carrying the pregnancy.  After enrolling with M-Afya, I received a message encouraging me to accompany her to the clinic and when I did, I learnt a lot; now I always take her to the clinic.” “After attending the men’s education forum, I now help her (wife) with cleaning the house and lifting heavy things. I am also very keen on feeding; I always make sure she takes a balanced diet all the time because I want her to be healthy so that she can give me a healthy baby. I also learnt the importance of having a scan done during pregnancy and that is why I have brought her (to the clinic) today.” 

Mathu, another beneciary of the project’s male involvement interventions was shocked when he learned how long postpartum mothers bleed. “I did not know that women continue to bleed for up to six weeks after delivery until I attended the education forum organized by M-Afya and this really shocked me. It has made me more supportive and now that she has delivered, I make sure she has sanitary pads to use,” he says. His wife, Elizabeth, confirms the support Mathu gave her during her pregnancy: “My husband was very keen on my pains, he was the one who noted that I am in true labor and insisted on us going to the hospital, otherwise I probably would have delivered at home waiting for the pains to intensify.”